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Scaling up Nutrition: A Framework for Action

International Nutrition Foundation

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While the United States, Canada, Spain and South Korea in cooperation with the Bill and Melinda Gates Foundation have launched funds to assist small farmers throughout the world, the international community seems to be rediscovering the importance of the poorest farmers. Not only does the livelihood of nearly half the population depend on them, but moreover, they represent the majority of poor populations around the world: according to figures from the World Bank, more than three quarters of the billion people who live below the poverty line are farmers.

Historically, agriculture has always played a central role in the economic development of a country and in the reduction of poverty, today it is more than ever necessary to restore it to the prominent position it deserves within development programs, because agriculture is at the crossroads of most of the concerns faced by the developing world.

A recent working paper, a collaboration between the World Bank, UNICEF, WFP, FAO along with a series of UN agencies and think tanks, has addressed the issue of nutrition, striving to demonstrate what is at stake and how best to improve it. Published in March 2010, with financial support from the Bill and Melinda Gates Foundation, the document entitled "Scaling up Nutrition: A Framework for Action” emphasizes that a massive effort to combat under-nutrition is not only essential to meeting MDGs, but that also we cannot succeed without it.

We recommend reading this excerpt because it demonstrates how agriculture and food security are at the heart of development issues.

Momagri editorial board

Scaling up Nutrition: A Framework for Action, Ch.5. Benefits of Scaling up the Set of Direct Nutrition Interventions, p. 7, International Nutrition Foundation

Results from field studies indicate that, at full implementation, the package of 13 interventions [to enhance nutrition in the highest burden countries]2 would result in a child mortality decline by about 1 million deaths per year, equivalent in the case of young children to 30 million life years (or, more precisely, what is referred to in public health as “disability-adjusted life years” or DALYs) saved3. Even partial progress would bring extraordinary results. For example, when 50% coverage is attained, 500,000 children’s lives would be saved. But, as already noted, the benefits of childhood nutrition interventions go far beyond mortality reduction to include cognitive and physical development, better health and higher earnings. A rigorous longitudinal study in Guatemala, for example, found that boys receiving a fortified complementary food prior to age 3 grew up to have wages 46% higher than those in the control group. The study estimated an increase in GDP of at least 2-3 percent4.

These substantial benefits are why it is important to address mild as well as severe undernutrition. Nutrition interventions are critical to achieving the MDGs. A recent United Kingdom consultation paper on nutrition made this point emphatically, underscoring the “clear evidence of the critical importance of nutrition to the achievement of all MDGs and in maximizing the effectiveness of all development interventions” 5. The following table illustrates the impact on the MDGs of the13 interventions – and other cost-effective interventions for nutrition.

TABLE: IMPACT OF UNDERNUTRITION INTERVENTIONS ON MILLENNIUM DEVELOPMENT GOALS

MDG 1: “eradicate extreme poverty and hunger”

Reducing “prevalence of underweight children under five years of age” is an agreed target for MDG 1. Reducing undernutrition increases economic growth.

MDG2: “achieve universal primary education”

Reducing undernutrition increases cognitive development and contributes to learning and school completion rates.

MDG 3: “promote gender equality”

Promoting better nutrition practices contributes to empowering women and to reducing discrimination against girls in family feeding practices

Reduces maternal and child mortality caused by the interaction of undernutrition with HIV/AIDS and other infectious diseases.

MDG 7: “ensure environment sustainability”

Better nutritional practices mean more effective use of available food and so better adaptation to environmental stress (Target 7A), increased health impact from improved access to water and sanitation ((Target 7C), and improvement in lives of slum dwellers (Target 7D).br />

MDG 8: “global partnership for development”

Addressing hunger and malnutrition around the world is a key element of, and argument for, the global partnership for development. This applies particularly for the least developed countries (Target 8B), where levels of undernutrition are highest.

The costing study is unique in pulling together a wide variety of data on cost-effectiveness. The package of recommended interventions shows excellent results, ranking high in comparison in costs per DALY to other public health interventions. Micronutrient supplementation and fortification scored particularly high. Even more striking are the inter-sectoral comparisons reflected in the “Copenhagen Consensus 2008”, which summarizes the views of a panel of leading economists, including five Nobel Laureates, on the top ten development investments overall. Nutrition interventions, from micronutrients to community based nutrition, ranked 1, 3, 5, 6, and 9 – far higher than for any other sector.

In sum, investment in the $10+ billion package of direct nutrition interventions recommended in the costing study promises exceptional payoffs in terms of mortality, morbidity, physical and mental growth, contributions to MDGs, lifetime earnings and overall development. Indeed, these core interventions offer among the very highest rates of return feasible in international development.

1 The International Nutrition Foundation (INF) was founded in 1985 to mobilize support for training, research, communication and policy related to food and nutrition in developing countries. 2 They were identified by a WorldBank report as the 13 most cost-effective interventions. Cf. Horton, M. Shekar, C. McDonald, A. Mahal et J.K. Brooks, « Scaling up nutrition :What will it cost ?”, World Bank, 20093 These estimates are approximate. If maximum feasible coverage is 90% then the reduction in child mortality would be 10% lower. However, if the countries with the remaining 10% of undernourishment were included, the reduction in child mortality would be 10% higher. So the two essentially cancel each other out. Further, if additional interventions were added as capacities are built, reductions in child mortality will increase, as would financing requirements.4 Hoddinott J, Maluccio JA, Behrman JR, Flores R, Martorell R. Effect of a nutritional intervention during early childhood on economic Productivity in Guatemalan adults. Lancet. 2008 Feb 2; 371 (9610): 411-6.5 DFID and Nutrition: An Action Plan, DFID, London, page 6.